Association between neutrophil-to-lymphocyte ratio and parathyroid hormone in patients with primary hyperparathyroidism

Abstract

Introduction Primary hyperparathyroidism (PHPT) is associated with adverse cardiovascular outcomes which may result from an increase in systemic inflammation. Previously we have shown that serum parathyroid hormone (PTH) levels are independently associated with inflammatory indicators. The neutrophil-to-lymphocyte ratio (NLR) is an inexpensive, widely available marker of inflammation. In the present study, we aimed to assess the longitudinal changes in NLR before and after parathyroidectomy. Material and methods This retrospective study included 95 patients diagnosed with PHPT who underwent parathyroidectomy between 2006 and 2016. Follow-up complete blood counts were available in 31 patients. Results At diagnosis, 43 (45%) patients presented with overt clinical symptoms and had higher serum calcium and PTH levels. Preoperative NLR was positively correlated with total white blood cell count ( p = 0.001), serum calcium ( p = 0.001), and PTH level ( p = 0.013). The NLR was not associated with sex, age, comorbidities, or parathyroid weight. Among patients who were cured of PHPT, the median NLR decreased from 2.26 to 1.77 after parathyroidectomy ( p = 0.037). There was no difference in hemoglobin, total white blood cells, or platelet count before and after surgery. Conclusions We found a positive correlation of preoperative NLR with calcium and PTH levels in PHPT patients. After curative parathyroidectomy, NLR modestly decreased without changes in other hematological parameters.

Does Parathyroidectomy Affect the Neutrophil/Lymphocyte Ratio, a Systemic Inflammatory Marker?

“…Lam et al found a negative correlation between the serum phosphate and NLR values before PTX in patients with PHPT. Still, they also noted that this was not at a statistically significant level [18]. In our study, we detected a significant negative correlation between the serum phosphate and NLR values before PTX (r = 0.331, p = 0.046).…”

“…They noted the regulatory effects of this procedure on systemic inflammation, which could also explain the beneficial role of PTX in anaemia, arterial stiffness, and survival in secondary hyperparathyroidism [ 23 ]. Lam et al detected a relationship between PHPT and systemic inflammation and found that systemic inflammation was reversible after rapid treatment [ 18 ]. Similarly, in our study, evaluating patients with PHPT, in the sixth month after successful PTX, there was a significant decrease was observed in NLR, which is an indicator of systemic inflammation.…”

“…In a study evaluating patients with hyperparathyroidism, Toraman et al found a significant negative correlation between the NLR and serum Ca values (r = -0.146, p = 0.011) [ 27 ]. Lam et al reported a positive and statistically significant correlation between the NLR and serum Ca values before PTX in patients with PHPT (r = 0.376, p < 0.01) [ 18 ]. In the current study, there was a statistically significant positive correlation between the pre-PTX serum corrected Ca and NLR values (r = 0.390, p = 0.017).…”

“…The neutrophil/lymphocyte ratio (NLR) is an inexpensive marker that can be easily calculated by dividing the neutrophil count by the lymphocyte count due to a simple blood test of systemic inflammation [12,13]. However, conflicting results have been reported as increased, unchanged, or decreased inflammatory markers after parathyroidectomy (PTX) in patients with hyperparathyroidism [12,[14][15][16][17][18].…”

Serum Inflammation-based Scores in Endocrine Tumors

“…Two studies confirmed these findings, one observing a positive correlation between serum NLR (but not PLR) and PTH levels in patients with hyperparathyroidism and identifying PTH as one of the main determinants of NLR, regardless the glomerular filtration rate, suggesting PTH as pro-inflammatory factor independent of renal dysfunction ( 88 ). The other study reported a correlation between preoperative NLR and both PTH and calcium levels in patients with primary hyperparathyroidism, with a significant 22% decrease in NLR after parathyroidectomy ( 87 ). Similarly, patients with secondary hyperparathyroidism had a significant decrease in NLR and PLR after successful parathyroidectomy, while those with persistent or recurrent disease had no changes, suggesting that effective parathyroidectomy may reduce systemic inflammation ( 86 ).…”